The administration of packed red blood cells and its influence on electrolyte and acid-base balance disturbances in vivo
Authors:
Uvízl Radovan; Klementa Bronislav; Neiser Jan; Fritscherová Šárka; Adamus Milan
Authors place of work:
Klinika anesteziologie a resuscitace, Fakultní nemocnice Olomouc
Published in the journal:
Anest. intenziv. Med., 22, 2011, č. 1, s. 13-18
Category:
Intensive Care Medicine - Original Paper
Summary
Objective:
Administration of large-volume blood transfusions can cause electrolyte and acid-base balance disturbances in the plasma of the patient. The ongoing metabolism and haemolysis in the transfusion unit can change the initial values of some biochemical parameters. The aim of this study was to describe the influence of the number of transfusion units and their age on the biochemical values in vivo.
Design:
Prospective observational study.
Setting:
Multidisciplinary intensive care unit (ICU) in a tertiary care centre.
Materials and methods:
We compared the biochemical values in the arterial blood before and after the administration of the transfusion. We recorded the data and analysed their dependence on the volume and duration of storage of the administered transfusion units (TU).
Results:
We examined 46 patients who received total 354 TUs of packed red blood cells (PRBC), mean 7.7 (range 2–38) TU of PRBC per patient. The mean duration of storage of the administrated PRBC was 16.2 days. The administration of 1 TU of PRBC led to a rise of K+ values by 0.07 mmol/l and a rise of lactate values by 0.13 mmol/l. Other biochemical values (pH, Ca++, Na+, glycaemia) were stable.
Conclusion:
The administration of large-volume blood transfusion can pose a significant risk of hyperkalaemia and hyperlactataemia.
Keywords:
erythrocyte – transfusion – hyperkalaemia – lactataemia – PRBC
Zdroje
1. Larsen, R. Anestezie. Praha: Grada publishing, 2004, p. 718–753.
2. Brecher, M. E. Noninfectious complications of blood transfusion. AABB technical manual, 2005, p. 577–600.
3. Ho, J., Sibbald,W. J., Chin-Yee, I. H. Effects of storage of red cell transfusion: when is it not safe? Crit. Care Med., 2003, 31, p. 687–697.
4. Uvízl, R. et al. Vliv stáří transfuzních jednotek erytrocytárních koncentrátů na koncentrace vybraných biochemických veličin. Anest. intenziv. Med., 2009, 5, p. 257–261.
5. Aboudara, et al. Hyperkalemia after packed red blood cell transfusion in trauma patients. J. Trauma, 2008, 64, p. 86–91.
6. Smith, H. et al. Cardiac Arrests Associated with Hyperkalemia During Red Blood Cell Transfusion: A Case Series. Anesth. Analg., 2008, 106, p. 1062–1069.
7. Hillyer, C. D., Hillyer, K. L., Strobl, F. J., Jefferies, L. C., Silberstein, L. E. Handbook of transfusion medicine. Academic Press, 2001, p. 275–282.
8. Larson, P. J. Other noninfectious coplications of transfusion. In Hillyer, C. D., Hyllier, K. L., Strobl, F. J., Jefferies, L. C., Silberstein, L. E. Handbook of transfusion medicine. Academic Press, 2001, p. 263–271.
9. Vítovec, J, Špinar J. Intenzivní péče v kardiologii. IPVZ: Brno, 1994, p. 12–14.
10. Zima, T. et al. Laboratorní diagnostika. Praha: Galén 2002, p. 276–278.
11. Hess, J. R., Sparrow, R. L., Van der Meer, P. F., Acker, J. P., Cardigan, R. A., Devine, D. V. Red blood cell hemolysis during blood bank storage: using national quality management data to answer basic scientific questions. Transfusion, 2009, 49, p. 2599–2603.
12. Luten, M., Roerdinkholder-Stoelwinder, B., Schaap, N. P., de Grip, W. J., Bos, H. J. Survival of red blood cells after transfusion: a comparison between red cells concentrates of different storage periods. Transfusion, 2008, 48, p. 1478–1485.
13. Walsh, T. S., McArdle, F., McLellan, S. A., Maciver, C., Maginnis, M., Prescott, R. J., McClelland, D. B. Does the storage time of transfused red blood cells influence regional or global indexes of tissue oxygenation in anemic critically ll patients? Crit. Care Med., 2004, 32, p. 364–371.
14. Lelubre, C., Piagnerelli, M., Vincent, J. L. Association between duration of storage of transfused red blood cells and morbidity and mortality in adult patients: myth or reality? Transfusion, 2009, 49, p. 1384–1394.
15. Yap, Koch et al. Clinical impact of blood storage lesions - Recent Reports. Ann. Thorac. Surg., 2008, 86, p. 554–559, 358, 1229–1239.
16. Weinberg, J. A., McGwin, G. Jr., Marques, M. B., Cherry, S. A. 3rd., Reiff, D. A., Kerby, J. D., Rue, L. W. 3rd. Transfusions in the less severely injured: does age of transfused blood affect outcomes? J. Trauma, 2008, 65, p. 794–798.
17. Eikelboom, J. W., Cook, R. J., Liu, Y., Heddle, N. M., Am Heart, J. Duration of red cell storage before transfusion and in-hospital mortality, 2010, 159, p. 737–743.
18. Basran, S., Frumento, R. J., Cohen, A., Lee, S., Du, Y., Nishanian, E., Kaplan, H. S., Stafford-Smith, M., Bennett- -Guerrero, E. The association between duration of storage of transfused red blood cells and morbidity and mortality after reoperative cardiac surgery. Anesth. Analg., 2006, 103, p. 15–20.
19. Koch, C. G., Li, L., Sessler, D. I., Figueroa, P., Hoeltge, G. A., Mihaljevic, T., Blackstone, E. H. Duration of red-cell storage and complications after cardiac surgery. N. Engl. J. Med., 2008, 20, p. 1229–1239.
20. Leal-Noval, S. R., Munoz-Gomez, M., Arellano-Orden, V., Marin-Caballos, A., Amaya-Villar, R., Marin, A., Puppo- -Moreno, A., Ferrandiz-Millon, C., Flores-Cordero, J. M., Murillo-Cabezas, F. Impact of age of transfused blood on cerebral oxygenation in male patients with severe traumatic brain injury. Crit. Care Med., 2008, 36, p. 1290–1296.
21. Weiskopf, R. B., Feiner, J., Hopf, H., Lieberman, J., Finlay, H. E., Quah, C., Kramer, J. H., Bostrom, A., Toy, P. Fresh blood and aged stored blood are equally efficacious in immediately reversing anemia-induced brain oxygenation deficits in humans. Anesthesiology, 2006, 104, p. 911–920.
22. Hess, J. R., Rugg, N., Knapp, A. D., Gormas, J. F., Silberstein, E. B., Greenwalt, T. J. Su1ccessful storage of RBCs for 10 weeks in a new additive solution. Transfusion, 2000, 40, p. 1012–1016.
23. Cid, J., Ramiro, L., Bertran, S., Martinez, N., Claparols, M., Maymo, R. M., Puig, L., Pla, R. P. Efficacy in reducing potassium load in irradiated red cell bags with a potassium adsorption filter. Transfusion, 2008, 48, p. 1966–1970.
24. Rose, B. D., Post, T. W. Clinical Physiology of Acid-Base and Electrolyte Disorders. 5th ed, McGraw-Hill: New York, 2001, p. 383–396, 898–910.
25. Friedman, D. F. Hepatitis. In: Hillyer, C. D., Hillyer, K. L., Strobl, F. J., Jefferies, L. C., Silberstein, L. E. Handbook of transfusion medicine, Academic Press 2001, p. 275–282.
26. Kiraly, L. N., Underwood, S., Differding, J. A., Schreiber, M. A. Transfusion of aged packed red blood cells results in decreased tissue oxygenation in critically injured trauma patients. J. Trauma, 2009, 67, p. 29–32.
27. Kaplan, H. S. et al. The medical event reporting system for transfusion medicine: Will it help to get the right blood to the right patient? Transfusion Medicine Reviews, 2002, 16, p. 86–102.
28. Zallen, G., Offner, P. J., Moore, E. E., Blackwell, J., Ciesla, D. J., Gabriel, J., Denny, C., Silliman, C. C. Age of transfused blood is an independent risk factor for postinjury multiple organ failure. Am. J. Surg., 1999, 178, p. 570–572.
Štítky
Anaesthesiology, Resuscitation and Inten Intensive Care MedicineČlánok vyšiel v časopise
Anaesthesiology and Intensive Care Medicine
2011 Číslo 1
Najčítanejšie v tomto čísle
- Classification and diagnosis of kidney injury – are they still imperfect?
- The administration of packed red blood cells and its influence on electrolyte and acid-base balance disturbances in vivo
- Evolution of Anaesthesiology and Resuscitation at Prague’s Medical Faculties
- New biomarkers in the diagnosis of renal dysfunction